1336228360 NPI number — RICHARD J HORBAL MD PC

Table of content: (NPI 1336228360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336228360 NPI number — RICHARD J HORBAL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD J HORBAL MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIDLAND ALLERGY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336228360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 W WACKERLY ST
Provider Second Line Business Mailing Address:
SUITE 2675
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48640-4722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-631-1010
Provider Business Mailing Address Fax Number:
989-839-8800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W WACKERLY ST
Provider Second Line Business Practice Location Address:
SUITE 2675
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-631-1010
Provider Business Practice Location Address Fax Number:
989-839-8800
Provider Enumeration Date:
11/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HORBAL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-631-1010

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X , with the licence number:  4301039488 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0E61134 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142136610 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1R00191 . This is a "HEALTHPLUS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 203484 . This is a "MCLAREN HEALTH PLAN MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0300900191 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 10505 30241 . This is a "COMMUNITY CHOICE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101348 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0300900191 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DG8718 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".